Prior Authorization Supervisor

Polaris Pharmacy Services•Covina, CA

6d•$68 - $70

About The Position

The Prior Authorization Supervisor is responsible for managing and identifying a portfolio of rejected pharmacy claims to ensure maximum payer reimbursement and timely billing to eliminate financial risks to Polaris and their customers. The Prior Authorization Supervisor must be responsive and courteous when addressing our customers’ needs. Successful Specialists are dedicated to meeting the expectations and requirements of the position; understanding customer information and using it to improve products and services we deliver; talking and acting with customers in mind; establishing and maintaining effective relationships with co-workers and customers, thus gaining our customers’ trust and respect. The Prior Authorization Supervisor will also provide leadership and guidance to the prior authorization team, ensuring efficient workflow.

Requirements

Able to read, write, speak, and understand the English language
Able to retain a large amount of information and apply that knowledge to related situations
Able to work in a fast-paced environment
Basic computer knowledge skills required
Basic math and analytical skills
Experience with alpha-numeric data entry
Proficient in Microsoft Word, Excel, and Outlook required
Customer Service
Results-oriented
Good organization/Attention to detail
Reliable
Problem solver
Able to work various shifts and days
Adaptability to an ever-changing environment
High School diploma or equivalent required
Minimum of one (1) or more years working as a pharmacy technician in a retail environment preferred (long-term care pharmacy preferred)
Framework LTC & General computer knowledge & 10-key Number Entry preferred
May sit or stand seven (7) to ten (10) hours per day
The employee is occasionally required to sit; climb or balance; and stoop, kneel, bend, walk
May be necessary to work extended hours as needed
May lift and/or move up to 30 pounds

Responsibilities

Manage and identify a portfolio of rejected pharmacy claims to ensure maximum payer reimbursement and timely billing to eliminate financial risks to Polaris and their customers
Research, analyze and appropriately resolve rejected claims by working with national Medicare D plans, third party insurance companies, and all state Medicaid plans to ensure maximum payer reimbursement adhering to critical deadlines
Ensure approval of claims by performing appropriate edits and/or reversals to ensure maximum payer reimbursement
Contact providers and/or facility contacts as necessary to obtain additional information
Monitor and resolve revenue at risk associated with payer set up, billing, rebilling, and reversal processes
Work as a team to identify, document, communicate, and resolve payer/billing trends and issues
Complete, communicate, and submit prior authorizations forms in a timely manner
Support training needs
Prepare and maintain reports and records for processing
Perform other tasks as assigned.
Follow all applicable government regulations, including HIPAA
Comply with departmental policies regarding safety, attendance, and dress code
Overtime, holidays, and weekends may be required and/or expected
Conduct job responsibilities in accordance with the standards set out in the Company’s Code of Business Conduct and Ethics, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards
Other duties as assigned; Job duties may vary depending on business needs